Bipolar disorder (BD), previously called manic depressive disorder, is one of the most difficult mental health conditions to treat. People with BD have significant mood changes that include manic (high) and depressive (low) episodes.
People with BD may be hesitant to experience major life changes, including pregnancy. Having BD doesn’t mean you can’t or shouldn’t have a baby — but it does mean that you should weigh the pros and cons associated with pregnancy and discuss your options with your partner and doctor.
If you have BD and plan to have a baby, you and your doctor will consider your overall well-being along with:
- how well your bipolar is managed
- what medications you’re currently taking
- the severity of your symptoms
Potential risks to your baby are also considered.
Effects of pregnancy on mental health
Pregnancy involves hormonal changes that can affect your mood. Some days, you might feel on top of the world. On other days, you might feel irritable and down. BD symptoms can become more prominent during pregnancy. This is also true with other types of mental health issues.
Women may find that pregnancy can alter their mood. The risk is greater if BD is left untreated during pregnancy.
Managing BD during pregnancy
In considering BD and a developing fetus, the biggest concerns are medications you may be taking to manage your condition. Mood stabilizers, such as divalproex-sodium (Depakote) or lithium (Eskalith), may be dangerous to a developing fetus.
The precise effects are unclear, however. One recent study published in the New England Journal of Medicine concluded that lithium, especially when taken during the first trimester, may increase the risk for cardiac malformations in fetuses. The study also reported that out of 663 infants who were exposed to the drug, only 16 were found to have these malformations.
Results from a review of studies indicated that valproate taken during pregnancy may increase the risk for neurological defects in infants. In many cases, the defects seemed to resolve by 12 months of age. The review authors noted that the data they worked with was low quality, and there’s a need for additional studies.
More studies are needed to support these findings, but the bottom line is that bipolar medications can impact fetal development. Other medications used in the treatment of bipolar disorder may also be harmful to the fetus. These medications include some:
To help prevent fetal complications, you must tell your obstetrician about all the medications you take for BD. You, your doctor, and obstetrician might decide to cease medications during pregnancy, at which time you’ll need to rely on other forms of treatment for bipolar, such as self-care, and psychotherapy. Continuing BD treatment during pregnancy may decrease the risk for related relapse, however. Your medical team will help you weigh the benefits versus the risks of stopping your medications during pregnancy.
Effects of mood disorders on fetuses
It’s not clear how bipolar itself can affect fetal development. There’s a chance that BD may be passed on to your child, but this isn’t an immediate concern during pregnancy. Scientists are still investigating the genetic relationship to bipolar.
Postpartum and BD
Aside from concerns during pregnancy, there’s some risks for a mother and her baby’s well-being immediately after labor. BD increases your risk for postpartum psychosis. Symptoms may be confused as postpartum depression, which is a common mental health illness experienced by many women after having a baby. This is true whether you have BD or not.
Postpartum psychosis is a rare, but serious condition that requires emergency treatment. It affects about 1 in 1,000 women. Symptoms include severe mania or depression that starts within two to three days after delivery. Hallucinations and delusions are also common with this type of postpartum mental illness. This can be extremely dangerous for both mother and baby.
Breastfeeding can also pose some challenges for new mothers with BD. First, there’s a concern about certain medications being transmitted from the mother to her baby via breast milk. While some antidepressants don’t seem to pose these risks, antipsychotics can be dangerous. Breastfeeding can also disrupt sleep, which is essential in preventing bipolar relapse.
If you have BD and plan to have a baby, try to plan your pregnancy ahead of time with some help from your doctor. That will make it easier for you to develop a plan to help keep you and your baby safe. This could entail:
- switching medications
- stopping medications altogether
- taking nutritional supplements
- self-care measures, such as adequate sleep
You may also consider:
- electroconvulsive therapy (ECT)
- regular exercise to naturally boost serotonin, the “feel-good” hormone
- talk therapy
- cognitive behavioral therapy
- support groups
- omega-3 fatty acids, like flax seed in addition to eating a couple of servings a week of low-mercury fish
- plant-based foods
There are numerous health considerations that are involved with any pregnancy. With BD, pregnancy can be safe, but you’ll want to try to plan ahead as much as possible.